test 1 – Currituck County

First Name: (required) *

Last Name: (required) *

Phone Number: (required) *

Email: (required) *

Direct TrafficEnter DataAdminister Vaccinations

Are you legally allowed by license or certification to administer vaccinations? (required) *YesNo

Please complete the following forms.

Questions or Comments

Once you have submitted your application EMAIL all 5 forms to COVIDApplicants@CurrituckCountyNC.gov.

If you wish to administer vaccinations please include a copy of your active RN license or active EMT certificate.